States Refusing To Give Medicaid Data To Grassley
11 CommentsBy Ed Silverman // November 18th, 2010 // 12:04 pm
Earlier this year, US Senator Chuck Grassley asked all 50 states to provide data on doctors who wrote huge numbers of prescriptions for specific drugs that are paid for by Medicaid programs. The move was prompted by reports indicating certain meds - notably, several widely used antipsychotics, as well as the OxyContin painkiller and Xanax anxiety pill - have been prescribed at particularly high rates.
The purpose in launching this inquiry was to determine whether the drugs are overprescribed and, consequently, costing taxpayers unnecessarily. And so Grassley, who is the ranking Republican on the committee and has launched several probes into the pharmaceutical industry, recently followed up with the Department of Health and Human Services in hopes of learning how the agency oversees payment and the extent to which fraudulent scrips may have been written.
Consider some of the trends: in Florida, the top Zyprexa provider wrote 1,356 scrips for 309 patients in 2008 and 1,238 for 236 last year, compared to the 10th-highest prescriber each year who wrote 256 for 55 patients and 192 scrips for 30 people, respectively (more here). In Texas, one doc authorized 13,596 filled scrips for Xanax in 2008, and increased that to 14,170 filled in 2009. The doc who occupied the lowest ranking in the top 10 prescribers wrote just 1,444 and 1,696, respectively. The list goes on…
In a recent exchange of letters, HHS noted that states are required to “monitor utilization rates” (see this). But what happens to that info? Some states, apparently, believe the data is not available to the public and have failed to comply with Grassley’s request. A spokeswoman says his staff is in the process of following up with a dozen states, because snail mail may have prevented some replies from making their way to the right desk. For the moment, we have been able to verify that four states have given Grassley the bum’s rush.
Which ones? Montana, Alabama, Wisconsin and New Jersey. So we decided to ask why Grassley was being ignored. Not surprisingly, our own inquiries were also ignored. For instance, Mary Dalton, the Medicaid and health services branch manager in Montana, refused to respond to several e-mails. So did Diane Welsh, chief legal counsel at the Wisconsin Department of Health Services (although, in fairness, she has since written at 2 pm today to remind us that she previously indicated the request would be passed to a spokesperson) and Carol Steckel, the Alabama Medicaid Agency commish.
UPDATE: The Wisconsin Department of Health Services spokesman writes us this afternoon to say the department “will not be responding to the Senator from Iowa. The records Senator Grassley requested do not exist. To comply with his request, we would have had to create new records at the expense of Wisconsin taxpayers. Because of both of these reasons we will not be responding.”
As for New Jersey, a spokeswoman for the Department of Human Services explained that Grassley required the states to a “very prescriptive chart” and the format “did not allow for a proper explanation of the information. As you know, data is dynamic by nature and we did not want to mislead the committee or the public with physician identifiers and undefined statistics. As such, NJ did not feel comfortable responding.” She added, though, that the state has a Medicaid fraud division that performs background checks and conducts oversight. In other words, it was too much work.
Further insight may be gleaned from a recent editorial in The Tuscaloosa News, which wrote Alabama officials explained the data was not provided because the “information might be misinterpreted and these doctors may have legitimate reasons for writing so many scrips.” Yet taxpayers are footing the bill and some patients may be overmedicated. This also raises the question about the possibility that some docs are improperly given incentives to write large number of prescriptions.
Meanwhile, some states are providing only partial information. Michigan, for instance, replied to Grassley, but would not provide the name of doctors (see this).
More may be learned when HHS replies to Grassley next month, as expected. But like it or not, the states have an obligation to respond, as most acknowleged by way of sending data to Grassley. The remaining handful should do the same - or run the risk of appearing to be indifferent, at best, to the possibilty that taxpayer dollars are being wasted, patients may be harmed and fraud may be occurring under their bureaucratic noses.
Searching2000
It’s nice to see that NJ, site of the Pharmalot campus, gave Pharmalot more (or as much?) courtesy as it gave to Senator Grassley/ HHS.
A very ipressive result! (Or, in the local vernacular, “Fugedaboutit!”)
MedicalQuack
I think in all fairness states are still gathering a lot of this information themselves with working on fraud detection not only on Medicaid but all over, like the Oxycontin Express in Florida which is a huge problem and people travel there to get it.
http://ducknetweb.blogspot.com/2010/07/oxycontin-express-in-florida-pain.html
A couple months ago right in New Jersey they found the biggest case of Medicare fraud with the company only having 3 employees.
http://ducknetweb.blogspot.com/2010/09/biggest-prescriber-of-medicaid-drugs-in.html
I do have to say too that the New Jersey legislature is getting smart and has a bill to look at the algorithms and mathematical formulas being used in healthcare, which is good thing as they realize how numbers can be created and queries become distorted.
http://ducknetweb.blogspot.com/2010/10/new-jersey-legislature-getting-smart.html
Sometimes too there are insurance companies who collect information and manage various programs so I might guess some of this may have to come from the contractors too, so perhaps another step in fulfilling his request to add on some additional time for a response.
Ben Hansen
Add Michigan to the list of states giving Grassley the bum’s rush.
In a letter dated June 4, 2010, Mich. Medicaid Director Steven Fitton told the Senator:
“MDCH launched the Pharmacy Quality Improvement Project (PQIP) in May 2005… The State considers this to be a very successful initiative. An impact analysis was performed that compared claims cost before and after a PQIP intervention between May 2005 and January 2006. The results showed a 22 percent reduction in claims and a 21 percent reduction in costs. During that six-month intervention period the NIDCH found the program produced cost savings of approximately $1.7 million.”
Regarding Grassley’s request for a list of top Michigan Medicaid drug prescribers, Fitton wrote:
“The State maintains that releasing the names of these providers will not point to outliers in the system, and could potentially lead to false accusations against well meaning and experienced physicians. For these reasons, the State can not, in good conscience, release the names of the physicians who fit this profile. We do, however, wish to be as cooperative as possible and will provide data with the names of the providers de-identified. Unfortunately, we are not able to provide the total number of prescriptions, but instead the enclosed attachment provides the total numbers of beneficiaries for which these prescriptions have been written.”
Fitton’s description of Michigan’s PQIP was deceptive, and his explanation for refusing to provide a list of top prescribers with total number of prescriptions was false and misleading; earlier this month we provided a top Grassley staffer on the Senate Finance Committee with solid evidence proving Fitton to be a liar.
We don’t know what, if anything, Sen. Grassley will do with any of the information that we provided to the Committee.
Ben Hansen
aka Methodius Isaac Bonkers, M.D.
Bonkers Institute for Nearly Genuine Research
http://www.bonkersinstitute.org
_______
Lisa Van Syckel
Ed,
I have a list of NJ Docs who prescribe antipsychotics to children as young as 6 months in the NJ medicaid program if your’e interested, I will be more than happy to forward it to you. I personally payed for the data which is part of NJ’s open records law.
Whatever
Where is Grassley going with this?
industry insider
Nice to see that someone has the “beytsim” to stand up to old Chuck. Hope it continues.
Stan
I’m glad to see 46 states complied with this U.S. Senator’s request already. Thankfully this Senator is keeping an eye on tax dollars. Unfortunately these 4 states need to get their head out of the sand.
Alabama’s Steckel has a reputation for secrecy and hiding public records. See here:
http://tinyurl.com/steckel
Wisconsin’s response is outlandish. Give me a break. They can spend hundreds of millions in
tax payer funds in reimbursing drugs but they can’t get their IT man down the hall to run the records for a UNITED STATES SENATOR? That’s just pea-brain foolishness.
bmartinmd
I don’t know. These wide-ranging requests by Grassley for state Medicaid and physician data raise the question of whether the Senator is overstepping his federal purview–and is acting more like a Grand Inquisitor than a US Senator. (And let’s not even discuss to what, if any, end Grassley will use the information). I, for one, am glad that a single congressmen cannot necessarily ride unbridled roughshod over whomever or whatever he pleases by making these kind of blanket demands (which he’s been doing for a while).
Although Medicaid is a program overseen by the US government, it is managed by the states. How obligated states are to provide certain information to Senator Grassley may be a thornier issue than what forum posters here are willing to acknowledge. Moreover, the licensing and oversight of physicians is clearly the purview of individual states, not the US govt (unless a physician is breaking some kind of interstate law, I would guess).
I’d really love to hear the input of a legal expert on these points. In the meantime, bully to Wisconsin, whose nose-thumbing response to Grassley appears to have been informed by the state’s DHS legal counsel.
Natural Cures for Tinnitus
On the surface, it seems Grassley has the best interest of patients at heart but of course he may have other motives. Chances are we’ll never know.
However, I believe it would be more than a little naive to suggest the big pharmaceuticals are above manipulating the system for massive profits so I’m willing to give the good senator the benefit of any doubt.
Jim
The only possible connection I can see to the Federal Govt would be if the individual states are funding this program with federal money, in which case they would be accountable to the executive branch of the Federal government that disburses those funds. Otherwise one seems to run into federalism issues and the tenth amendment.
However, if the Senator wants to subpeona companies that make unlawful claims that their products “treat or prevent disease” without FDA approval, I have no objection to that.
Stan
Thankfully, a U.S. legislator is watching out for our tax dollars. Overutilization of Medicaid (mostly funded by federal dollars) absolutely needs oversight.